Burden of cardiovascular disease in Pakistan – insight from global burden of disease study 2019

Background: Pakistan, currently the fifth-largest country by population globally, has experienced a population increase of over 100% since 1990. It is facing an escalating challenge from cardiovascular diseases (CVD). The Global Burden of Disease (GBD) 2019 study provides an in-depth evaluation of Pakistan's health situation since 1990, offering essential insights into the nation's overall health conditions. Methods: The data were obtained from the Global Burden of Disease Study 2019, which provides records for global, regional, and national burden of diseases. Specifically, data regarding CVD and its subtypes, morbidity, and mortality in Pakistan and globally from 1990 to 2019 were used for comparison. Data on the number of deaths, disability-adjusted life years (DALYs), age-standardized mortality rates (ASMRs), and age-standardized DALY rates (ASDRs), including their 95% uncertainty intervals (UIs) per 100,000 individuals, were analyzed. The changes over time from 1990 to 2019 were analyzed using the estimated annual percentage change (EAPC) and the respective 95% confidence interval (95% CI). Results: From 1990 to 2019, the yearly count of deaths caused by CVD in Pakistan almost doubled, rising from 172,526 (95% UI, 147,996 to 197,521) to 341,108 (95% UI, 291,723 to 405,509). The ASMR for CVD remained relatively unchanged, moving from 329.39 (95% UI, 279.95 to 381.52) in 1990 to 357.88 (95% UI, 307.76 to 423.57) in 2019, with an EAPC of 0.09% (95% UI -0.09% to 0.31%), despite a global decline. The ASMR for males was stable, with a figure of 327.96 (95% UI, 276.88 to 387.59) in 1990 increasing to 376.84 (95% UI, 295.07 to 472.46) in 2019; likewise, the ASMR for females saw little change, going from 331.47 (95% UI, 261.88 to 416.47) in 1990 to 337.34 (95% UI, 280 to 420.44) in 2019. An inverted U-shaped trend was observed for both overall and sex-specific CVD ASMR and ASDR in Pakistan. On a global scale, a reduction in ASMR was noted for both males (EAPC, -0.3%; 95% CI, -0.35 to -0.25) and females (EAPC, -0.35%; 95% CI, -0.4 to -0.3). Ischemic heart disease continued to be the primary contributor to the burden of CVD, followed by ischemic stroke. The trend in ASDR mirrored that of ASMR for both genders in Pakistan. Conclusion: Between 1990 and 2019, the overall CVD ASMR and ASDR exhibited an inverted U-shaped trend, remaining stable in Pakistan while decreasing globally. In the 1990s, Pakistan's CVD burden was more in line with the global burden; however, by the 2010s, it had surpassed the global CVD burden. To effectively tackle the CVD burden, policymakers need to prioritize the allocation of resources toward healthcare across various sectors. This initiative demands collaboration from all parties involved in the healthcare field, including policymakers.